Epidemiology

The widespread availability of aspirin (acetylsalicylic acid, or ASA) in prescription and over-the-counter preparations, confusion between product names and brand names, and the ease with which incremental chronic dosing can cause toxicity make salicylism a common and sometimes fatal occurrence. Data from the American Association of Poison Control Centers Toxic Exposures Surveillance System showed that, in 1996, aspirin was implicated in 25,281 exposures, with 12,385 cases (49 percent) treated in a health care facility; 48 deaths (0.2 percent of cases) were attributed to salicylate toxicity. 1

Many people use over-the-counter medications without realizing that they may contain significant amounts of salicylate. For example, Pepto Bismol (261 mg of salicylate per 30 mL) will deliver large amounts of salicylate in patients who overuse the product. Children may become salicylate toxic from extensive application of keratolytic agents or other agents containing oil of wintergreen (methyl salicylate). One milliliter of a 98% methyl salicylate contains 1400 mg of salicylate. Liniments and products used in hot vaporizers have high concentrations of methyl salicylate, and an ingestion of 5 to 10 mL can be lethal for an infant or a toddler.

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